The diagnosis of congestive heart failure (CHF) is not standardized, and its manifestations is the elderly are poorly understood. Objective measures of cardiac performance (echocardiography) show a decline in diastolic function with age, but the clinical significance is not known. We propose to study the importance of diastolic dysfunction in the elderly, and to provide the descriptive epidemiology of the determinants, correlates, and outcomes of CHF in the institutionalized population. All patients will receive a thorough clinical evaluation, a functional assessment, and a echocardiogram. CHF will be diagnosed according to clinical criteria, and the relation between clinical CHF and objective cardiac performance will be determined. We will also determine the effects of different etiology, medication and comorbidity on clinical CHF, functional status, and echocardiographic cardiac performance. We will determine whether diastolic dysfunction represents a pathologic process or if it is part of the physiology of normal aging, by measuring the association between diastolic performance and clinical symptomatology (controlling for level of systolic function). The final segment of study will be longitudinal follow-up of patients of determine the impact of cardiac functional measures on mortality. We will described the relations between various medications and clinical subsets and overall mortality rate, with an aim of delineating the best strategy for the evaluation and treatment of a debilitated elderly patient.